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Monthly Archives: September 2014

Chronic pain is often difficult to define. Different therapists and researchers will define it as pain lasting longer than 6 weeks, some over 3 or 6 months. What it means is pain that lasts for longer than the original injury (if there was one) would normally be expected to cause painful symptoms.

The theory of what happens is that the nervous system becomes hypersensitised to a painful input, possible from an injury, and continues to send signals to the brain to say there is still a painful injury in the neck/back or any other body part. Often, people who have chronic pain experience it closely with stress, or have negative emotions related to pain, all of which can exacerbate the pain. Explain Pain by Butler and Mosely is a great book on the subject which goes into detail but is easy to understand.

A common cycle that people can get into with chronic pain is experiencing pain, not knowing what caused it which can lead to thinking the pain is damaging. Then the person will become fearful of moving if it causes the pain, they will start to avoid moving. When we stop moving, our muscles become deconditioned and do not support the skeleton so well which can lead to further injury or discomfort and so the cycle begins again.

Other cycles of pain which happen frequently are when someone has chronic pain and has a ‘good’ day, they then rush out and do everything they’ve been unable to do whilst in pain. This leads to a ‘bad’ day, or many days, following this, and again the to-do list piles up. This is a boom and bust cycle, or ‘push-crash’.

Sleep is frequently affected by pain and can cause people to become very fatigued, less able to cope, and then to experience more pain as a result of tiredness and stress.

Added to that are concerns that no-one believes you, it’s ‘all in your head’ and what can be done about it.

Maybe you have a good day and try to do some exercise, go for a run maybe because you’ve realised how unfit you’ve become. It maybe goes a little like this:

There seems to be this belief, especially among the running world, that pain is a necessary part of exercise. It’s all about ‘pushing through’ and ‘feeling the burn’. Running websites are full of broad, but rather unhelpful, statements:

Hmm, not really going to help us in this case. Anyway, you’ve gone for that run, ended up unable to move for a week. You then, quite understandably, come to the conclusion that exercise isn’t for you and won’t help.

Then, does this cycle of fear – avoiding activity – becoming deconditioned go on forever? Let’s hope not. There’s plenty you can do to reverse the vicious cycle and turn it into a virtuous one.

Firstly, relaxation – of the body and mind – is a great step towards recovery. You might think you’re spending all day relaxing if you can’t move with pain. But with stress, worries and scary pain distracting you, is this really relaxation? There’s a lot to be said for taking time to become aware of what is happening in the body, even if at first you don’t change it.

This is a good example of a guided body scan. But it doesn’t matter which you use as long as it’s one you find relaxing. And you don’t get annoyed by the voice/music/script! So have a search around. There are plenty other relaxation techniques out there, again it’s about finding one that actually helps you relax.

Next, you might want to explore positions of ease. A physiotherapist can help you find different positions to get into to help reduce discomfort.

An important part of the cycle of recovery is breaking the boom and bust cycles, and learning to pace and space activities.

This is very personal and the exact duration of an activity needs to be worked out based on your stamina and which activities provoke pain. But to give an example, if you know that walking for 20 minutes flares up your pain, we often suggest you then walk for 10 or fewer minutes on a regular basis (this could be 4 minutes and 2 minutes, the same rules apply). It’s then important that this is repeated on a regular basis, every day or second day; and built up very slowly. On average 10% per week. Often this will be worked out with a bit of trial and error, as chronic pain can be very unpredictable. Pacing can take a lot of forward planning and there are some great planning tools available. It can also be quite frustrating when you first see how little you are able to do. But it is about doing the same small amount regularly and building up gradually.

A lot of Pilates exercises can combine the above treatments. They can be performed in your particular position of ease. The focus on breathing and movement can be relaxing, and the exercises can be personalised to your needs. Your Physiotherapist will work with you to find exercises which are comfortable and achievable. Pilates exercises do not need to be on the floor if you find it difficult to get on and off the floor. They do not need to be lying down if this is an uncomfortable position. The beauty of Pilates exercises is that they can work around your needs and abilities, gradually building strength.

The concentration, focus and precision of Pilates can really start to change the way your body functions and start the progress in the right direction. And after a session, you can stretch out comfortably and focus on relaxing through the body.

Pilates does not necessarily cure the pain, but can be a great tool for helping you to manage the pain and get back to the things you enjoy.

You might be wondering why you would want to do what is predominantly lying-down exercise to benefit your standing-up and walking activity. Well, as you will see, there are many benefits to golfers from Pilates. Let’s start by discussing why Pilates is practiced and loved by Pro Golfers, as the stakes are so much higher for them and they will be sure to follow a fitness regime which protects their musculoskeletal system and improves their performance.

Lee Westwood practiced Pilates after developing nerve dysfunction and pins and needles his arm – he began practicing Pilates, lost a stone and regained control of his swing.

Tiger Woods believes that the physical conditioning he gets from Pilates gives him an advantage and extra gear.

Annika Sorenstam is very smart about how she exercises and trains. She can perform several hundred repetitions of strengthening for her “core” muscles every day without hurting herself. Not all of these repetitions are the typical abdominal crunches. She incorporates Pilates training into her workout for variety and to keep her workout safe.

Dave Duvall: “I’ve added yoga to my routine recently, and combining that with my Pilates programme gives me all of the cardiovascular workout I need. Pilates is a method of conditioning that involves hundreds of exercises designed to improve strength and flexibility without adding bulk.”

The golf swing produces a complex combination of joint mobility and stability along with highly controlled coordination of the whole body. Efficient coordination of multiple linked joints is needed to achieve an effective swing path. The golf swing involves a chain through the whole body, the connection from your feet into your calves, through your legs and into your torso, then down the arms into the club which finally connects with the ball. However, it is repeated frequently, think about how many times you repeat this movement throughout the course of a game. Therefore, even small errors at any point in the chain can cause injury through repetition of the same fault. An injury may not arise at the point where the problem is, for example a calf strain may actually be due to poor recruitment in the core and gluteals (bottom muscles), therefore the calf muscles are overused.

To give an example of the kinetic chain in action, here are the primary muscles which activate during the swing of a right-handed golfer:

Quads (front of the thigh) on the right side

Hamstrings (back of the thigh) on the left side

Adductors (inner thigh) on the left side

Glutes (bottom muscles) on the left side

Rectus abdominus (superficial abdominal muscle) on the right side

Obliques (middle abdominal muscles) left to right

Latissimus dorsi (back and shoulder) on the right side

Pectorals (chest) on the right side

Rotator cuff (shoulder muscles) right side

And that’s just the muscles around the torso, think also of the foot and calf muscles and the muscles down the arm and into the wrist which all play their role in stabilising and activating the swing.

As well as the individual muscles activating, there has to be good timing of the activation – control and coordination. There must be mobility in the joints underlying the muscles to allow these movements to take place effectively, for example, if the upper back does not have the rotation required to move through the full range of the swing, this can lead to problems elsewhere, like the low back and hips. This can be made worse by having poor control of the core muscles which stabilise the low back. The muscles themselves need the strength to generate the power to hit the ball at speed. As a golfer you also need great balance to ensure your body can cope with the demands of the swing.

Looking at the muscles involved above, it is clear that golf will develop one side of a muscle group more than the other. This in itself can cause problems by creating muscle imbalances which can cause problems within the game and in everyday life as well.

A poor swing can give rise to a number of different problems, it can also be caused by underlying problems. Firstly, many amateur golfers are self-taught, and while they may be able to get the ball from A to B, they may have picked up bad habits. They may over-correct (swing too far), this can worsen muscular imbalances, for example, poor core stability coupled with tightness in the rotator cuff.

Golf injuries are broadly categorised as either overuse or traumatic injury. An overuse injury may arise from a performance fault which often develop as a consequence of compensations for muscle imbalances, and restrictions of rotation or uncontrolled weight shifting. Often golfers are totally unaware of these problems as they are non-painful. However, repeating poor movement techniques can lead to injury and will certainly reduce performance.

The most common golf injuries are (in order or prevalence): low back pain, wrist, elbow and shoulder injuries. Low back pain has been quoted as accounting for between 25 and 54% of all injuries sustained in golf.

So, why practice Pilates as a golfer? In a nutshell, Pilates teaches you to use the deep muscles of the torso and effective breathing patterns to control the spine. Pilates helps you to learn to recruit the deep postural muscles, ensure every muscle is doing its job at the right time, it encourages good posture and improves flexibility and strength. All of these elements are required for good golf performance, preventing injury and improving function on and off the golf course.

Sports physician Vijay Vad worked on the PGA tour and suggested that pilates provides “tripod of benefits: 1.stamina, 2. power for distance, 3. injury prevention”.

For all round injury prevention, within yourself you can modify your fitness, flexibility, balance and core stability. Pilates can help with these. A golfer is also exposed to risks not related to individual fitness, such as the weather and playing surface and the weight and size of equipment. When carried over the five to six miles walked over a round of golf, any poorly fitting bag can become very uncomfortable, especially if it is a one-shoulder design. A trolley and clubs which are measured to fit you are a great investment to prevent any problems arising from carrying bags.

The consequences of imbalances of stability and mobility of muscles leads to altered swing path and ball flight, reduced power and distance and injury

It’s not all negative!!!! You can do things to help – some golfers go through their career injury free but majority experience some problems and it’s knowing how to cope with injury and most importantly how to stop them from happening in the first place.

Exercise 1 – Backswing:

Specific golf swing problems include backswing sway, where the golfer’s hands drift too far away from the body pulling the torso on the backswing.Too much lateral movement and the lack of balance that entails effects the flight path – slice or hook, neither are welcome! An inability to rotate the upper torso is detrimental to power generation (we’re not suggesting Rory suffers from this problem, he is demonstrating a great backswing above!) .

Corrective Pilates Exercise:

CORE TWIST WITH HIP ROTATON

Increases Rotatory motion of Torso

Beginner – spine twist in sitting with resistance band

Intermediate – working the shoulderblades by drawing a resistance band apart and twisting in high kneeling

Fault: Chicken Winging: Lifting the non-target elbow on backswing changes the angle of the club & swing path, smothers the ball or hitting the top due to shoulder girdle instability.

Corrective Pilates Exercise:

BOW AND ARROW

Stabilizes shoulder joint working through full range of motion

Strengthens the kinetic chain

using magic circle pull ring to target side then opposite side sitting or standing

using theraband pull on band like bow and arrow at the same time as rotating torso

Make sure abdominal muscles are recruited throughout.

Exercise 3 – Stance:

Fault: poor posture at address, manifesting as S-shape or C-shape posture. Excessive arching of the back causing pain, compression of muscles causing stress due to weak abdominals and gluteal muscles, tight low back and hip flexors.

Corrective Pilates Exercise:

BIRD DOG/SUPERMAN

Strengthens abdominals

Challenges stability of torso/pelvis/shoulders

First, find position and control on hands and knees

Beginner level: single arm or leg extension

Intermediate: extend both at the same time

Advanced: Progress with resistance band

Alignment and posture essential

Exercise 4 – Rotation for Swing:

Fault: Reduced rotation. Changes the angle of the body – poor swing pattern complicated by over compensation in other areas. Poor control and increased compressive forces result in low back pain and/or shoulder pain. This is due to reduced flexibility in thoracic (upper back) region and poor core control.

Corrective Pilates Exercise:

THREAD THE NEEDLE

Start in a neutral spine position in four point kneeling. As you breathe out bring one arm under the body and through the opposite arm and hold 5-10 seconds to feel the stretch. Then slowly raise the same arm out to the side above the head so you are rotating the opposite way and opening the chest. Hold 5-10 seconds to feel a stretch.

Alternate sides and repeat 5-10x each side.

If you have any questions about these exercises, please see your Pilates instructor.